Criticism of e-cigarettes in US study is unrepresentative of real-world use

Friday 3 February 2017

A limited US study suggesting a connection between e-cigarettes and potential cardiovascular health problems is making a comparison that does not reflect practical use of the devices.

University of California researchers have based their conclusion on findings from a test group that is not representative of real-world e-cigarette use, nor large enough to be certain of such claims. It relies on a small sample size of 42 non-smoking volunteers, consisting of 23 habitual e-cigarette users and 19 individuals who had previously never used an e-cigarette.

Marc Michelsen, Senior Vice President of Corporate Affairs and Communications, Fontem Ventures, said, “This study compares habitual e-cigarette users with people who have never smoked. But e-cigarette use is a practice almost universally undertaken by smokers and ex-smokers. E-cigarettes are not intended for, or widely used by, non-smokers.”

The 2015 Nation Health Interview Study[1] by the US National Center for Health Statistics found that 48% of e-cigarette users were current cigarette smokers and 55% were recent former smokers (who quit smoking within the past year). Just 3% of adults who used e-cigarettes had never previously smoked.

“This study does not compare the effect of continued smoking against e-cigarette use, but instead, it compares non-smokers with e-cigarette users. Given that the overwhelming majority of e-cigarette users are smokers, that comparison is more relevant when assessing cardiovascular risk. It is not recommended to start using e-cigarettes if you aren’t already a smoker,” he continued.

Prof. Paul Aveyard, Professor of Behavioural Medicine at the University of Oxford, UK, has publicly criticised[2] this study, “If a person cannot stop smoking in other ways, public health advice is to switch to e-cigarettes either partially or wholly. This small study does not change that advice. Compared with smoking, e-cigarettes are a better option.”

In countries where regulators and public health bodies have invested sufficient time researching and debating the science around vaping, many have concluded that e-cigarettes are significantly less harmful than smoking and therefore have an important role to play in reducing tobacco-related disease worldwide.

All these groups are moving towards a broad scientific consensus that vaping, when compared to smoking, could present a critical tool in global harm reduction. Importantly, these groups are focusing on the ‘relative risk’ of vaping compared to cigarettes – a very important distinction because nearly all e-cigarette users are current or former tobacco users looking for an alternative.